Healthcare Provider Details

I. General information

NPI: 1245605583
Provider Name (Legal Business Name): GAYLEN N. BARTLETT III D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2015
Last Update Date: 12/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7966 W THUNDERBIRD RD SUITE # 102
PEORIA AZ
85381-4902
US

IV. Provider business mailing address

7966 W THUNDERBIRD RD SUITE # 102
PEORIA AZ
85381-4902
US

V. Phone/Fax

Practice location:
  • Phone: 623-225-5560
  • Fax:
Mailing address:
  • Phone: 623-225-5560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8484
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number8484
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number8484
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number8484
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number8484
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number8484
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number8484
License Number StateAZ
# 8
Primary TaxonomyN
Taxonomy Code111NT0100X
TaxonomyThermography Chiropractor
License Number8484
License Number StateAZ
# 9
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number8484
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: